Shirah Vollmer MD

The Musings of Dr. Vollmer

Is Psychiatry Dying?

Posted by Dr. Vollmer on June 11, 2015

Imagine a world where psychiatrists disappeared? Primary care physicians took over psychotropic prescribing, doctoral and masters level clinicians did psychotherapy and mental status assessments were done by neurologists. As Prozac was born in 1988, and psychiatrists quickly reinvented themselves as “psychopharmacologists” and no longer promoted the doctor-patient relationship, and diminished the importance of a good assessment, the field has narrowed itself so much that it could disappear. There is nothing that we do that can’t be replaced by a primary care physician or a nurse practitioner because we gave up our flag carrying notion that what we do is understand the whole patient. This is what no other physician has the time or inclination to do. By shortening the standard appointment to fifteen minutes, we gave up the uniqueness of our field, the quality of relationships with patients that no other doctor has the privilege of experiencing. We leverage this relationship to have the patient help himself. This, more than medication, is the fundamental healing power that we hold. Shame on us for letting that slip through our fingers. If psychiatry does die, we have only ourselves to blame.

7 Responses to “Is Psychiatry Dying?”

  1. Ashana M said

    Psychiatrists originally treated the very sick and the very rich. I think that will most likely continue. The first, out of necessity, the second as a hobby.

  2. Shelly said

    I don’t think that psychiatrists let the field die. I think that it was outside factors and the influx of other lay professionals (psychologists, social workers, and the like), who all wanted a piece of the pie so that you were forced to divide up and decide what the state of mental health would be. Psychiatrists could then become consultants to PCPs who were, as yet, unsure how to prescribe medications for the mentally ill. The severely mentally ill would always need psychiatrists, but I feel, the long-term in depth optional psychoanalysis of which you often blog and write about will soon become a thing of the past. Sure that is a gift patients give themselves, but therapists who are not psychiatrists often feel they give psychoanalysis or psychotherapy without the need for the in-depth psychoanalytic training which you do.

  3. Eleanor said

    Shirah I have read with interest and fascination your recent posts on the state of psychiatry these days and I’ve started to add to the discussion several times but have so many various viewpoints swirling through my mind, so rather than go into a rant (which would be boring to most), I’ve stayed quite….besides I’m aware many of my views are terribly one sided as they come from my personal experiences only and certainly don’t apply to everyone.

    In a nutshell….our culture is different, and many people going into medicine these days have a different mindset that years ago….Physicians (I refuse to call them “providers”) and their practices are in many ways controlled by insurance companies now. An insurance executive told me “…we need to see proof on paper, lab tests, etc. to pay”……. Patients (I refuse to call they “clients”), even those who could easily afford to pay something, expect everything to be paid for…everything… and I’ve heard some gripe about a $10 increase in co-pay)…….in psychiatry, a “quick fix” is paid for by insurance….long term psychotherapy is not. Beginning with my time in analysis I have always had a deep interest in the psychoanalytic process and the depth and layers of our minds…..used to subscribe to the American Psychoanalytic Journal….bought books…ie: Karen Horney, etc etc. I continue to have a life long interest in all this but I’ve found that others don’t at least in many of my experiences.

    The word “psychiatry” in itself is intimidating to many who could use psychotherapy, because they associate psychiatry (MD trained) with those with severe mental illnesses that are part of hospital settings. I would never refer to you or anyone doing the kind of work you do as a “counselor” but that is what many seem to be comfortable with. Another strike against psychiatry…unfortunately. When I was in analysis I kept my treatment quiet and would never say I was seeing a “psychiatrist”….public opinion can be harsh. OK enough…( LOL…..yes I could go on…)…:-)

    • Thank you, Eleanor. One major point of doing this blog is to attack that stigma. I am determined to make a small dent in an effort to publicize that the psychiatrist, trained in psychoanalysis, has many tools in his toolbox, such that a large variety of patients can benefit from his care. With all of the disturbing changes in medicine in general, and psychiatry in particular, the good news is that the internet was born, allowing people like me to get the word out. Feel free to rant. It feels good!

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